MEDICARE: DR. DOUGLAS WAYNE JOHNSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	3122	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	C43801-6	OTHER	HI	HMSA

General Provider Information

NPI Number	:	1700869427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS WAYNE JOHNSON M.D.

Provider Business Mailing Address
First Line	:	1380 LUSITANA ST
Second Line	:	SUITE 401
City	:	HONOLULU
State	:	HI
Zip	:	96813-2449
Country	:	US
Telephone Number	:	808-531-7541
Fax Number	:	808-531-7542

Provider Business Practice Location Address
First Line	:	1380 LUSITANA ST
Second Line	:	SUITE 401
City	:	HONOLULU
State	:	HI
Zip	:	96813-2449
Country	:	US
Telephone Number	:	808-531-7541
Fax Number	:	808-531-7542

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	09/16/2022

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Directions to “ DR. DOUGLAS WAYNE JOHNSON M.D.” Practice Location

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